ITS 80 - Surveillance 101: Developing and Implementing Standardized Definitions for Healthcare-associated Mold Infection Surveillance and Review

Background: Immunocompromised patients are at an increased risk for opportunistic mold infections, which can be a large source of morbidity and mortality. Exposure to molds may occur within the community or healthcare environment. Clinical research definitions for diagnosing invasive mold infections exist, however there are no published standardized definitions for healthcare-associated (HA) mold infection surveillance. Surveillance for HA mold infections allows facilities to establish baseline data, track trends over time, and investigate potential environmental sources.

Methods: Infection Prevention revised definitions to facilitate surveillance and tracking for HA mold infections in July 2020. The definition includes minimum time from admission and level of disease invasiveness. A matrix was created with risk stratification levels (high, medium, and low) to classify, and compare HA mold infection data. Based on the level of concern, a tiered investigation was performed. Cases with the most concern for HA was classified as high concern and was reviewed with a hospital epidemiologist and an environmental assessment was completed.

Results: From July 2020 – June 2021, the mean number of HA mold infections of high concern was 2.25 infections per month, with notable increases in August 2020 (six infections) and May 2021 (six infections). From July 2021 – June 2022, the mean number of HA mold infections of high concern was 2.83 infections per month, with notable increases in November and December 2021 (six and eight infections, respectively). Investigations into the increases revealed gaps in environmental cleaning and other issues related to patient room environments which were remediated. The number of infections in the following months returned to baseline.

Conclusions: Internal definitions for HA mold infection surveillance were developed and applied allowing standardization and monitoring of mold infections over time. Concerning infections that appear to have been acquired in the healthcare environment should be investigated for potential sources.